While exposure details for many of these cases are murky, this outbreak appears to have started with an imported case with recent travel to Saudi Arabia, who was treated at two different hospitals over a 2-week period before being diagnosed.

Today we get an update on five additional cases, two of whom are children who tested positive after having contact with case #2 listed below. One is listed as in stable condition, while the other is described as being `asymptomatic’.

While pediatric infections with MERS-CoV has not been unheard of, it has been fairly rare. The percentage of the population under the age of 20 in the Middle East runs approximately 40%, but cases in this age bracket represent only about 2% of the cases reported.

Younger patients - but children in particular - seem to have fewer symptoms with MERS-CoV infection and are often described as `asymptomatic’. Given the lack of studies on the subject, one can’t say with any confidence exactly why this should be.

Between 7 and 10 August 2015, the National IHR Focal Point of Jordan notified WHO of 5 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths.

Details of the cases

A 78-year-old male from Amman city developed symptoms on 26 August and, on 1 September, was admitted to hospital. This hospital, which the patient frequently visited due to chronic conditions, has been experiencing a MERS-CoV outbreak. He passed away on 4 September and tested positive for MERS-CoV on 5 September. Investigation of possible epidemiological links with the MERS-CoV cases in the hospital or with shared health care workers is ongoing. The patient had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

A 53-year-old male from Amman city developed symptoms on 27 August and, on 5 September, was admitted to hospital. The patient, who had comorbidities and was a heavy smoker, tested positive for MERS-CoV on 8 September. He passed away on 7 September. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.

A 7-year-old female from Amman city tested positive for MERS-CoV while asymptomatic on 10 September. Currently, she is still asymptomatic and under observation in a negative pressure isolation room in a hospital. The patient, who has no comorbidities, is a contact of a laboratory-confirmed case (see above – case no. 2). She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

A 10-month-old female from Amman city developed symptoms on 9 September. The patient was admitted to hospital on 10 September and, on the same day, tested positive for MERS-CoV. Currently, she in stable condition in a negative pressure isolation room on a ward. The patient, who has no comorbidities, is a contact of a laboratory-confirmed case (see above – case no. 2). She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

A 65-year-old female from Amman city developed symptoms on 3 September and, on 9 September, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 10 September. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient visited a laboratory-confirmed MERS-CoV case (see DON published on 1 September – case no. 3) at the hospital that has been experiencing a MERS-CoV outbreak. She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

Contact tracing of household and healthcare contacts is ongoing for these cases.

The National IHR Focal Point of Jordan also notified WHO of the death of 1 MERS-CoV case that was reported in a previous DON on 1 September (case no. 3).

Globally, WHO has been notified of 1,569 laboratory-confirmed cases of infection with MERS-CoV, including at least 554 related deaths.